Dental arch and airway expander device and method

ABSTRACT

An oral appliance that attaches to molars or bicuspids and that has the capability for side-to-side expansion and contraction in one unit as a self-stopping mechanism. Further, one embodiment can be activated to compress or expand and be deactivated in two planes of side-to-side or front-to-back, along three different arms/bridges respectively. This is to say that one arm can compress front-to-back while the other arm expands, the jaw/teeth front-to-back, simultaneously. With proper arrangements and anchorage preparation the device shown and described can move front teeth forward or backward or back teeth forward or backward independently on either side of the mouth.

RELATED APPLICATIONS

This application is a continuation of application Ser. No. 15/599,736,filed May 19, 2017, which itself is a continuation-in-part ofapplication Ser. No. 14/931,566 filed on Nov. 3, 2015, now U.S. Pat. No.10,004,574, issued Jun. 26, 2018, which in turns claims benefit ofprovisional application Ser. No. 62/074,360 filed Nov. 3, 2014, and alsoclaims benefit of co-pending provisional application Ser. No. 62/502,086filed on May 5, 2017, all of which are incorporated by reference as iffully set forth herein.

BACKGROUND

Orthodontists, dental practitioners and medical-dental researchers areconstantly searching for new and improved ways to correct the problem ofconstriction of the dental arches that also contribute to theovercrowding or overlapping of teeth. This condition, by narrowing ofthe tongue space and retraction of the tongue back to the airway, cancause the constriction of the upper airway in the retropalatal (behindthe palate), retroglossal (behind the tongue) and hypoglossal (behindand below the tongue) area. As a result, the upper airway of the patientbecomes constricted and causes resistance to the air passage, especiallyduring the deeper stage of sleep when the upper airway muscles relax andcannot provide ideal support for the patency of the airway.

In the past, many different methods have been used in order to alleviatethe constriction and collapse of dental arches and dental crowding. Onemethod that has been utilized by orthodontic practitioners is that ofdental expansion of the upper and lower dental arch as well as dentaland or orthopedic expansion of the upper jaw in transverse direction.There have also been attempts to do so by front-to-back expansion of thedental arches by advancing the upper or lower anterior teeth forward ordistalizing (retracting) the upper and lower back teeth furtherbackward. Although the combination of these two protocols meansexpansion in transverse and front to back plane of space and makes morelogical process, there have not been any appliance designs capable ofcombining these two protocols.

One dental arch expander device on the market today is a lower lingualarch to advance mandibular incisors. It does not require activation orde-activation chair side adjustments. This appliance is capable offront-to-back expansion only. As a result, it cannot expand the side toside or transverse relationship of dental arch. Another drawback of thissystem is that it needs to be customized for each patient (e.g., in alaboratory) and cannot be provided in a kit for a chairside use.

Another dental arch expander device that is on the market today isdepicted in FIG. 1 and sometimes is referred to as the Arnold expanderdevice. The Arnold expander device 100 develops the arch using aspring-loaded split-lingual arch housed in a tube. More specifically,the Arnold expander device 100 includes a wire 102, a spring coil 104, atube 106, and bands 108. The spring coil 104 passes into the tube 106 tocreate the spring-loaded split-lingual arch. The bands 108 anchor thedevice 100 to the patient's molar teeth. Tension on the spring coil 104is set before the device 100 is initially placed. Further adjustment isnot usually necessary. Once the desired space has been created, theappliance can be made passive by carefully pinching the tube 106 tightagainst the wire 102 with a pair of heavy wire cutters or tube crimpingpliers. This device 100 is not capable of advancing the dental archesfrom back to front or distalizing the back teeth.

SUMMARY

This summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This summary is not intended to identify key features ofthe claimed subject matter, nor is it intended to be used as an aid indetermining the scope of the claimed subject matter.

Embodiments of dental arch and airway expander devices described hereinprovide improved orthodontic appliances for use in nasal cavity and/ordental arch expansion for the purpose of correcting dental crowdingand/or providing tongue space for treating the upper airway constrictioncaused by retraction of the tongue and constriction of the nasal cavity.In some embodiments, the appliance includes left and right molarattachment portions, each of which, in some embodiments, is securable tothe patient's left or right first or second molars on the right and leftside of the mouth in the upper or lower jaw. In some embodiments, thereare sliding wires that connect to the tongue side of the molar bandsusing removable tubes. In some embodiments, each tube has two insertsthat slide vertically to slots soldered or otherwise attached to thetongue side of the attachment portions. In some embodiments, slidingwires that connect to the tongue side of the attachment portions usingnon-removable connection tubes are soldered or otherwise attached to thelingual side of the attachment portions. A sheath can be provided in afront area behind the upper and lower front teeth of the appliance toconnect the right and left extensions of the wires. This sheath providesa sliding slot as a telescopic system such that the anterior ends of thewires, bent as hooks in some embodiments, can slide freely toward oraway from each other for purpose of expansion or constriction. In someembodiments, there are two loaded springs (e.g., compression springs)sliding freely over the right and left side wire compressed between theconnector tubes attached to the attachment portions and the sheath infront. These loaded springs can be used to produce an outward forcebetween the connector tubes coupled to the left and right attachmentportions in the back and front connector tube behind the anterior teeth.The term “anterior teeth” refers essentially to the canines andincisors.

In some embodiments, sliding wires connect to the tongue side of theattachment portions using removable connector tubes. In someembodiments, each tube has two inserts that slide vertically to slotssoldered or otherwise attached to the tongue side of the attachmentportions. This connector tube provides a sliding slot as a telescopicsystem such that the posterior end of the sliding wires on each side ofthe mouth, bent as hooks in some embodiments, can slide freely backwardor forward for purpose of sagittal (front-to-back) expansion orconstriction of the dental arch. In some embodiments, there are twoloaded springs sliding freely over the right and left side wirescompressed between the posterior connector tubes attached to theattachment portions and the sheath in front. These springs can be usedto produce an expansion or constriction spring force in a sagittaldirection between the anterior sheath and posterior connection tubesconnected to the left and right attachment portions.

In one example, the connector tubes are coupled to the attachmentportions via an attachment system for easy attachment and removal of theconnector tubes to and from the attachment portions. In one example, theattachment system has self-locking capability. Also, as a safetyfeature, the connector tubes and attachment portions can be locked withwire to prevent unintended disengagement of the connector tubes from theattachment portions. In one example, the attachment portions includebonding that bonds the connector tubes to the lingual side of thepatient's molars. In one example, a portion of the connector tubes isflat with no inserts for proper fit of the connector tubes to thelingual surfaces of first or second upper or lower molars. In thisdesign, the flat end of tubes can be bonded to the lingual surface offirst or second molars with no need for the attachment portions toinclude a band around the molars. This option makes the applianceesthetically enhanced with no features extending on the labial surfaceof the molars. In some embodiments, the connector tubes are soldered orotherwise fixedly attached to the tongue side of molar bands of theattachment portions.

In one example, the connector tubes are coupled to the attachmentportions using an attachment system for easy attachment and removal ofthe connector tubes to and from the attachment portions. In one example,the attachment system has self-locking capability. Also, as a safetyfeature, the connector tubes and attachment portions can be locked withwire to prevent unintended disengagement of the connector tubes from theattachment portions. One benefit to this appliance is that it requiresless maintenance and has fewer parts, therefore being less cumbersomeand more cosmetically appealing for the patient. Another benefit is thatthe appliance is less expensive because it requires less hardware andmaintenance.

Embodiments of dental arch and airway expander appliances describedherein create lateral expansion of the nasal cavity as well as lateralexpansion or constriction of the posterior teeth (second and firstmolars, second and first bicuspids) while advancing the position of theanterior teeth (canines and incisors) and distalizing (or moving back)the posterior teeth. Once the posterior teeth are expanded to theirdesired position, either the expander device stops further expansionautomatically as determined by the set size of expansion width or can beinactivated. Adjustments of the expander device can be made withoutremoval from the patient's mouth. The insertion assembly to the molartubes is removable for adjustment without damage or discomfort to thepatient.

Further, the position of the device behind the teeth on the roof of themouth or floor of the mouth along with the singular connection to themolar bands creates a device that is less obtrusive to the patient andtherefore more cosmetically desirable. A singular connection point onthe lingual side of the molar band also allows for connection of variousdevices, such as braces or headgear, to the buccal side of the band.

In another example, the sheath placed lingual to incisor teeth alongwith sliding wires can be curved to conform to the lingual side of theincisors. This alteration can be done at the chairside in the beginningor during the treatment progress. This option provides more idealpositioning of the incisors and canines during or at the completion ofthe advancement of the anterior teeth.

In some embodiments, these attachment portions include bonding orcementation on the occlusal and/or labial surface of upper or lowerfirst or second bicuspids, can be used in conjunction with class two orclass three type mechanical devices or rubber bands to be utilized toadvance or retract that dental arch in relationship to the oppositedental arch in sagittal direction for proper improvement of class two orclass three malocclusions to class one relationship. This option,combined with use of fixed type three or type two mechanical devices,reduces the patient's noncompliance failure.

In embodiments, springs form a part of the device and are used to applya user determined amount of pushing or pulling force to the teeth beingtreated. FIGS. 8 and 9 show an embodiment that combines side-to-side andfront-to-back expansion capability in one unit as a self-stoppingmechanism. Further, this embodiment can be activated to compress orexpand and be deactivated in two planes of side-to-side orfront-to-back, along three different arms/bridges respectively. This isto say that one arm can compress front-to-back while the other armexpands, the jaw/teeth front-to-back, simultaneously. With properarrangements and anchorage preparation the device shown and describedcan move front teeth forward or backward or back teeth forward orbackward independently on either side of the mouth.

DESCRIPTION OF THE DRAWINGS

The foregoing aspects and many of the attendant advantages of thisinvention will become more readily appreciated as the same become betterunderstood by reference to the following detailed description, whentaken in conjunction with the accompanying drawings, wherein:

FIG. 1 depicts a prior art dental arch expander device;

FIG. 2A depicts a view of an embodiment of a dental arch and airwayexpander orthodontic appliance, in accordance with the embodimentsdisclosed herein, being worn on the upper jaw and teeth of a patient;

FIG. 2B depicts a bottom view of the arch portion of the dental arch andairway expander orthodontic appliance depicted in FIG. 2A;

FIG. 2C depicts a view of upper jaw and teeth of a patient with firstmolar bands of the dental arch and airway expander orthodontic appliancedepicted in FIG. 2A;

FIG. 2D depicts a view of a molar tooth of a patient with first molarband of the dental arch and airway expander orthodontic appliancedepicted in FIG. 2A;

FIG. 2E depicts another view of a molar tooth of a patient with firstmolar band, in accordance with the embodiments disclosed herein;

FIG. 3 depicts a view of another embodiment of a dental arch and airwayexpander orthodontic appliance, in accordance with embodiments disclosedherein, being worn on the lower jaw and teeth of a patient;

FIG. 4A depicts a view of another embodiment of a dental arch and airwayexpander orthodontic appliance.

FIG. 4B depicts a view of the bottom of another embodiment of theappliance depicted in FIG. 4A;

FIG. 5A depicts a view of a top of another embodiment of a dental archand airway expander orthodontic appliance;

FIG. 5B depicts a bottom view of the embodiment of the appliancedepicted in FIG. 5A;

FIG. 5C depicts the appliance depicted in FIG. 5A with attachmentportions as bonding to lower teeth of a patient;

FIG. 6A depicts an embodiment of ball hinged pads, usable in accordancewith any of the bonding mechanisms described herein;

FIG. 6B depicts an additional embodiment of ball hinged pads, usable inaccordance with any of the bonding mechanisms described herein;

FIG. 7A depicts a top view of a connecting system for connecting variousconventional orthodontic devices when the attachment portion does notinclude a band around the molar or bicuspids;

FIG. 7B depicts a cross-sectional view of a connecting system forconnecting various conventional orthodontic devices when the attachmentportion does not include a band around the molar or bicuspids.

FIG. 8 is a bottom view of an alternative embodiment of dental arch andairway expander orthodontic appliance, being worn on the upper jaw andteeth of a patient;

FIG. 9 is an expanded detail view of a portion of the expander of FIG.8.

DETAILED DESCRIPTION

The process of dental arch development is designed to move the backteeth posteriorly as well as laterally and front teeth anteriorly in themouth to allow room for the other teeth and to expand the circumferenceof the dental arches larger to correct the dental crowding and toaccommodate space for the volume of tongue allowing the forwardpositioning of the tongue out of the pharyngeal air space. Whendesigning a product to perform this lateral and backward and frontalpositioning of the teeth, two factors may be considered. The firstfactor is how to make a product that performs this type of toothmovement in an efficient manner. The second factor is how to make aproduct that is functional for the user, comfortable for patient, aswell as cosmetically appealing without inhibiting the tooth movementprocess.

For effectiveness and convenience of practitioner and patient, a dentalarch and airway expander orthodontic appliance should limit periodicactivation or deactivation by chair side adjustments, but at the sametime have self-limiting capability to avoid unwanted expansion and/oradvancement of the teeth. The self-limiting capability avoids unwantedmovements in case the patient misses an appointment to be checked by thepractitioner. When patient compliance is an issue, a fixed appliance isalways preferred.

Once the desired lateral expansion has been created, the applianceshould either stop by its self-limiting capability, be made passive bycarefully pinching the sheath tight on both sides against the wire witha pair of heavy wire cutters or tube crimping pliers, or tying thesliding wires inside of the tube using a stainless ligature wire.

Once the desired sagittal expansion and space has been created, theappliance should either stop on its own, be made passive by carefullybending the sliding wire behind the tube attached to the first andsecond molars, or tying the bent end of the sliding wires inside of theconnector tubes using stainless ligature wire to a hook which is weldedto the inside of the molar bands.

FIG. 2A illustrates an embodiment of a dental arch and airway expanderorthodontic appliance 200. FIG. 2A depicts the upper palate of a patientwith the appliance 200 resting on the lingual side of the upper teeth.The appliance 200 includes an arch portion 202 (FIG. 2B) on the lingualside of the upper teeth and attachment portions 204 attached to thepatient's first molars. In the embodiment shown in FIG. 2A, theappliance 200 has a U shape that is fitted to the patient's upper orlower teeth. In some embodiments, including the embodiment shown in FIG.2A, the appliance 200 includes left and right halves that aresymmetrical.

The arch portion 202, which is depicted in greater detail in FIG. 2B,includes two sliding wires 206 that pass inside of connector tubes 208.In some embodiments, the sliding wires 206 are stainless steel wires.The connector tubes 208 are configured to be coupled to the attachmentportions 204. In some embodiments, each of the connector tubes 208includes one or more inserts 220 configured to couple the connectortubes 208 to the attachment portions 204. Each of the wires 206 extendsinto a sheath 210 which is positioned inside of the anterior teeth. Insome embodiments, the sheaths 210 are stainless steel sheaths. Each ofthe sheaths 210 has an opening 212. In some embodiments, the openings212 are positioned to face the palate or floor of the mouth of thepatient. Each of the wires 206 has an anterior end 214 in the front ofthe mouth that is bent into the opening 212. The wires 206 are capableof sliding freely inside of the sheaths 210 until the anterior ends 214contact the sides of the openings 212. In the depicted embodiment, thesheaths 210 include seams 250. In practical implementation, the sheaths210 may originally be in an open configuration with the seams 250 opensuch that the wires 206 may be inserted into the sheaths 210. Then,after the wires 206 are inserted into the sheaths 210, the seams 250 canbe closed to the configuration shown in FIG. 2B so that the wires 206are kept in place.

Loaded springs 216 are located around the wires 206 between theconnector tubes 208 and the sheaths 210. The sheaths 210 are used forholding and connecting the anterior ends 214 of the wires 206 when theforce generated by the expansion springs 216 expands. The sheaths 210connect the two halves of the appliance 200 and maintain relativespacing between the wires 206. In some embodiments, the sheaths 210 areintegrally formed as a single piece. The lengths of openings 212 in thesheaths 210 determine the maximum expansion width of the appliance 200.The anterior ends 214 of the wires 206 slide inside the sheaths 210 byforce generated by the loaded springs 216 until the bent anterior ends214 touch the right or left side of the openings 212. In this way, theopenings 212 in the sheaths 210 function as stops to limit the maximumlateral expansion of the appliance 200.

In some embodiments, when in place and fully activated, the wires 206laterally extend within the sheaths 210 inside of the upper or loweranterior teeth directly behind the incisors with a 2- to 3-mm space leftbetween the sheaths 210 and the bicuspid teeth. In some embodiments, theanterior ends 214 of the wires 206 are prefabricated with a bentformation in the last 1.5 mm. In some embodiments, the anterior ends 214are positioned inside of the openings 212 of sheaths 210, the wires 206extend laterally to almost touching the first bicuspids, and then thewires 206 are bent distally and toward the back of mouth. The wires 206extend and pass through the inside of the connector tubes 208. In someembodiments, the wires 206 extend between 6 mm and 10 mm toward the backof the mouth.

In the embodiment shown, the wires 206 have posterior ends 218 that arebent toward the roof or floor of the patient's mouth. In someembodiments, the bend at the posterior ends 218 of the wires 206 isabout 90 degrees. In some embodiments, the bend at the posterior ends218 is either prefabricated or made by the clinician at the time ofinstallation of the device in the patient's mouth. The bent posteriorends 218 function as self-limiting stops. In the depicted embodiment,the force of the expander springs 216 causes the wires 206 to slide inthe connector tubes 208 until the bent posterior ends 218 of the wires206 touch the distal ends of the connecting tubes 208. In someembodiments, the location of the bends on the posterior ends 218 of thewires 206 is selected such that the bends on the posterior ends 218 ofthe wires 206 will reach the connector tubes 208 when the desiredadvancement of the anterior teeth is reached. If during the treatment, aclinician determines that enough advancement of the anterior teeth hasbeen acquired, the clinician can create a bend in one or both of thewires 206 extending distal of the connector tubes 208 at the chairsidewithout removal of the device. Creating such a bend can prevent furtheradvancement of the anterior teeth. This is a significant advantage overother devices, such as the device 100 (FIG. 1) which does not haveself-limiting capability, allowing overextension of the wire 102 todisengage the wire 102 from the tube 106 and leave the spring coil 104loose.

During installation of the appliance 200, the connector tubes 208 arecoupled to the attachment portions 204. The attachment portions 204 aredepicted in greater detail in FIGS. 2C and 2D. Each of the attachmentportions 204 include a band 222 configured to be anchored on one of thepatient's teeth (e.g., on a molar). The attachment portions 204 includeslots 224 located on an inward portion of the bands 222. In oneembodiment, the slots 224 are oriented in a vertical from occlusal togingival direction on the lingual side of the first molars in maxillaryand mandibular arches. Each slot 224 is open at least on the occlusaland/or gingival end to accommodate insertion of the inserts 220 into theslots 224. In some embodiments, the slots 224 are located approximatelyat the middle of the lingual part of the bands 222 horizontally and theopenings are directed vertically, with the opening of the slots 224 atthe middle of vertical height of the bands 222 on the lingual side ofthe first molar. In some embodiments, the location of the slots 224 isprefabricated and welded to the band 222 in the factory or can be weldedin the lab later. In other embodiments, the connector tube 208 is weldedto the band 222 in the lab to form a coupling between the arch portion202 and the attachment portions 204 without the use of the inserts 220and the slots 224.

In some embodiments, the inserts 220 of the connector tubes 208 areremovably insertable into and securely coupled to the slots 224 on thepatient's first or second molars. An embodiment of a connector tube 208coupled to an attachment portion 204 is depicted in FIG. 2E. In theembodiment shown, each of the inserts 220 has a locking mechanism 226that, after passing through the slots 224, extend beyond the opening ofthe slots 224 by spring activation to prevent unintended dislodging ofthe inserts 220 from the slots 224. In some embodiments, the inserts 220also include an unlocking mechanism 228 configured to permit the inserts220 to be removed from the slots 224. In the embodiment shown in FIG.2E, the unlocking mechanisms 228 are in the form of slots below thelocking mechanisms 226. A tool (e.g., a wire director device) can beinserted into the unlocking mechanisms 228 and used to push the inserts220 towards each other. This motion pushes the locking mechanisms 226into the slots 224 such that the inserts 220 can be removed from theslots 224 for removal of the connector tube 208 from the attachmentportion 204.

In the embodiments depicted in FIGS. 2A and 2C to 2E, the each of theattachment portions 204 includes a hook 230 coupled to the lingual sideof the band 222. Each connector tube 208 has, on the occlusal side, anotch 232. The hook 230 and the notch 232 are usable for furtherpreventing against any unintended disengaging of the connector tube 208from the attachment portions 204. More specifically, a practitioner maywind a wire around the hook 230 and the notch 232 to prevent relativemotion of the connector tube 208 and the band 222. In some embodiments,the bands 222 also have a connecting piece 234 attached to its buccalside. The connecting pieces 234 are attachable to various conventionalorthodontic devices, such as wires in braces or connection assembliesfrom other class II mechanisms, class III mechanisms, or any other classof mechanisms.

In some embodiments of constructing the arch portion 202, the wire 206is inserted into the sheath 210, through the loaded spring 216, and theninto the connector tube 208. To install the arch portion 202 on theattachment portions 204, the inserts 220 of the connector tubes 208 areinserted into the slots 224 of the attachment portions 204. In someembodiments, the wire 206 has a diameter in a range from about 0.030inches to about 0.060 inches. In some embodiments, the wire 206 extendsposteriorly towards the molars approximately parallel to the lingualside of the molars. The posterior end of wire 206 passes through theconnector tubes 208 attached to the molar band and, in some embodiments,extends about 6 mm to 10 mm beyond the distal portion of the connectortubes 208. At the posterior ends 218 of the wire 206, the wire 206 bendsvertically about 1 mm. In some embodiments, the posterior ends 218 areslightly slanted laterally to avoid irritating the patient's tongue. Insome embodiments, the inserts 220 of the connector tubes 208, which areinserted in the slots 224 welded on the inside of the bands 222, aresecured by tying a wire ligature around the notch 232 on the occlusalportion of the connector tubes 208 and around the hook 230 and/or toextension of the inserts 220 that extend beyond the slots 224. When wire206 is in place, the expansion spring 216 maintains contact at one endwith the open end of the sheath 210 and on the other end to theconnector tube 208.

An alternate embodiment of a dental arch and airway expander orthodonticappliance 300 is depicted in FIG. 3. The appliance 300 includes an archportion 302 on the lingual side of patient's teeth and attachmentportions 304 attached to the patient's molars. The arch portion 302includes wires 306 that pass inside of connector tubes (Not Shown). Theconnector tubes are configured to be coupled to the attachment portions304. The wires 306 extend into a sheath 310 which is positioned insideof the anterior teeth. The wires pass inside the sheaths 310. Thesheaths 310 have openings 312 through which anterior ends 314 of thewires 306 are permitted to extend. The wires 306 are capable of slidingfreely inside of the connector tubes and inside of the sheath 310.Loaded springs 316 are located around the wire 306 between the connectortubes and the sheath 310. In some embodiments, the attachment portions304 and the connector tubes are similar to the attachment portions 204and the connector tubes 208 described above.

In the depicted embodiment, the attachment portions 304 include bondingmedium 348 configured to attach the connector tubes to the occlusalsurface of molar, or bicuspids. In some embodiments, the connector tubesinclude one or more bonding mechanisms, such as a single mesh layer, adouble mesh layer, a bonding pad, a hinged boding pad, or any othermechanism to aid in the attachment of the bonding medium 348 to theconnector tubes. Such bonding mechanisms are described in greater detailbelow with respect to FIGS. 5A and 5B.

In the embodiment shown in FIG. 3, the appliance 300 is configured toexpand laterally as the wires slide within the sheaths 310 in responseto the force exerted by the loaded springs 316. In other embodiments,the appliance 300 is configured to expand sagittally as the wire 306slides within the connector tubes in response to the force exerted bythe loaded springs 316. In contrast to the expander device 100 depictedin FIG. 1, the lateral and sagittal expansion of the appliance 300 canbe relatively symmetrical with substantially similar forces exerted byeach of the loaded springs 316. The lateral and sagittal expansion ofthe appliance 300 can also be intentionally asymmetrical withsubstantially dissimilar forces exerted by each of the loaded springs316. In some embodiments, the wires 306 are formed as two wires 306where the anterior ends 314 of the two wires 306 are bent and located inopenings 312 of the sheath 310 and the posterior ends 318 of the twowires 306 are bent after the two wires 306 are fed through the connectortubes.

An alternate embodiment of an arch portion 402 of a dental arch andairway expander orthodontic appliance is depicted in FIGS. 4A and 4B.The arch portion 402 includes connector tubes 408 that are closed at theposterior end. Posterior ends 418 of wires 402 pass through anterioropenings of the connector tubes 408. The posterior ends 418 are bentthrough openings 436 in the connector tubes 408. In some embodiments,the posterior ends 418 are bent vertically about 1 mm and slightlyslanted laterally to avoid irritating the patient's tongue. In someembodiments, the posterior ends 418 of the wires 406 are capable ofsliding about 6 mm to 10 mm inside the openings 436 of the connectortubes 408.

Each of the wires 406 extends into a sheath 410 which is positionedinside of the anterior teeth. Each of the sheaths 410 has an opening412. In some embodiments, the openings 412 are positioned to face thepalate or floor of the mouth of the patient. Each of the wires 406 hasan anterior end 414 in the front of the mouth that is bent into theopening 412. The wires 406 are capable of sliding freely inside of thesheaths 410 until the anterior ends 414 contact the sides of theopenings 412. Loaded springs 416 are located around the wires 406between the connector tubes 408 and the sheaths 410. The force generatedby the loaded springs 416 causes the patient's arch to expand laterallyas the anterior ends 414 of the wires 406 slide within the openings 412of the sheath 410. The force generated by the loaded springs 416 alsocauses the patient's arch to expand sagittally as the posterior ends 418of the wires 406 slide within the openings 436 of the connector tubes408.

In some embodiments, the connector tubes 408, which are closed at theirposterior end, are coupled to attachment portions (e.g., attachmentportions 204 depicted in FIG. 2A). The posterior ends 418 of the wires406 are bent (e.g., in the last 1.5 mm) and positioned inside of theopenings 436 of connector tubes 408. The wires 406 extend anteriorly toalmost touching the first bicuspids then bend inwardly and extend andpass through inside the sheath 410. In case the full advancementcapability of appliance is desired, then this process continues untilthe bent posterior ends 418 of the wires 406 are touching the frontsides of the openings 436 inside connector tube 408, preventing furtherwithdrawal of the wire 406 from the connector tube 408, and therebylimiting spread of the patient's anterior teeth to this predeterminedextent. The posterior ends 418 act as self-limiting stops by touchingthe anterior portion of the openings 436 in connecting tubes 408 whenthe desired advancement of the anterior teeth is reached.

In FIG. 4A, the bent anterior ends 414 of the wires 406 and the bentposterior ends 418 of the wires 406 are free to slide within the sheaths410 and the connector tubes 408. If, during treatment, a cliniciandetermines that enough advancement of the anterior teeth has beenacquired, the clinician may tie the bent anterior ends 414 of the wires406 together and/or the bent posterior ends 418 of the wires 406 toinserts 420 or to any other portion of the arch portion 402, such asposterior notches (e.g., to posterior notches 544 discussed below) toprevent further expansion of the arch portion 410 laterally and/orsagitally. In FIG. 4B, a first wire 438 is tied between the bentanterior ends 414 of the wires 406. The first wire 438 prevents lateralexpansion of the arch portion 402 because the first wire 438 does notpermit the wires 406 to move away from each other. In case where lateralconstriction of the dental arch is desired, the first wire 438 shown inFIG. 4B can be replaced by constricting elastic or spring between thebent anterior ends 414 of the wires 406. The elastic or spring isconfigured to constrict the arch portion 402 because the elastic orspring pulls the wires 406 toward each other if the constriction of thedental arch is desired to close existing spaces. In this case wherelateral constriction of the dental arch is desired, the springs 416 maybe removed, cut, or otherwise inactivated such that the springs 416 donot exert an expanding lateral force on the arch portion 402.

Second wires 440 are tied between the bent posterior ends 418 of thewires 406 and inserts 420 on the connector tubes 408. The second wires440 prevent sagittal expansion of the arch portion 402 because thesecond wires 440 do not permit the wires 406 to move away from theconnector tubes 408. In other embodiments, the clinician can tie thebent posterior ends 418 of the wires 406 to hooks 456 extending from theconnector tubes 408. In one embodiment, the posterior end 418 of eachwire 406 that is received within the connector tube 408 is bent in theshape of a hook. By tying these bent posterior ends 418 using astainless steel second wire to the hook of the attachment portion, theadvancement or distalization expansion of the appliance can be stoppedshort of final expansion limit. In an alternative embodiment, theposterior ends 418 of the wires 406 which extend beyond the connectortubes 408 may be removed, which may make it easier for some patients totolerate the appliance.

In the case where sagittal constriction of the dental arch is desired,the second wires 440 may be replaced by constricting elastic or springs,which are tied between the bent posterior ends 418 of the wires 406 andinserts 420 on the connector tubes 408. The elastic or spring isconfigured to pull the wires 406 toward the connector tubes 408 toconstrict the arch portion 402 in a sagittal direction. In otherembodiments, the clinician can tie the bent posterior ends 418 of thewires 406 to hooks 456 extending from the connector tubes 408 usingelastic or springs that may allow for sagittal constriction of the archportion 402. In one embodiment, the posterior end 418 of each wire 406that is received within the connector tube 408 is bent in the shape of ahook. By tying these bent posterior ends 418 using constricting elasticsor springs to the hook of the attachment portion, the front teeth can beretracted back and/or the posterior teeth can be protracted forward. Inthis case, the springs 416 may be removed, cut, or otherwise inactivatedsuch that the springs 416 do not exert an expanding sagittal force onthe arch portion 402.

An alternate embodiment of an arch portion 502 of a dental arch andairway expander orthodontic appliance 500 is depicted in FIGS. 5A and5B. The appliance 500 placed in a patient's mouth is depicted in FIG.5C. The arch portion 502 includes connector tubes 508 that are closed atthe posterior end. Posterior ends 518 of wires 506 pass through anterioropenings of the connector tubes 508. The posterior ends 518 are bentthrough openings 536 in the connector tubes 508. Each of the wires 506extend into a sheath 510 which is positionable inside of the anteriorteeth. Each of the sheaths 510 has an opening 512. In some embodiments,the openings 512 are positioned to face the palate or floor of the mouthof the patient. Each of the wires 506 has an anterior end 514 in thefront of the mouth that is bent into the opening 512. The wires 506 arecapable of sliding freely inside of the sheaths 510 until the anteriorends 514 contact the sides of the openings 512. Loaded springs 516 arelocated around the wires 506 between the connector tubes 508 and thesheaths 510.

In the embodiments shown in FIGS. 5A and 5B, lateral expansion of thearch portion 502 is prevented by a first wire 538 and sagittal expansionof the arch portion 502 is prevented by second wires 540. The first wire538 is tied between the bent anterior ends 514 of the wires 506. Thefirst wire 538 prevents lateral expansion of the arch portion 502because the first wire 538 does not permit the wires 506 to move awayfrom each other. Second wires 540 are tied between the bent posteriorends 518 of the wires 506 and posterior notches 544 on the connectortubes 508. The second wires 540 prevent sagittal expansion of the archportion 502 because the second wires 540 do not permit the wires 506 tomove away from the connector tubes 508. In some embodiments, the archportion 502 includes hooks 556 and the second wires 540 could be tiedbetween the bent posterior ends 518 of the wires 506 and hooks 556instead of the posterior notches 544. In some cases, the posteriornotches 544 will be covered with a bonding medium when placed in apatient's mouth and the hooks 556 may extend out from the bondingmedium. In these cases, the hooks 556 may be usable after bonding evenif the posterior notches 544 are not usable. In some embodiments, thearch portion 502 includes the hooks 556 but not the posterior notches544 (e.g., in the case that the posterior notches 544 irritate thepatient's mount).

In some embodiments, the first wire 538 and the second wires 540 areplaced on the arch portion 502 before the arch portion 502 is insertedinto a patient's mouth to prevent premature expansion of the archportion 502. The first wire 538 and the second wires 540 are thenremoved after the arch portion 502 is inserted into a patient's mouth topermit expansion of the arch portion 502 within the patient's mouth.Each of the connector tubes 508 includes a flat portion 542. Theconnector tubes do not include inserts (e.g., inserts 220). Instead oftying the bent posterior ends 518 of the wires 506 to inserts, aclinician can tie the posterior ends 518 of the wire 506 to theposterior notches 544 at the most posterior end of the flat portions 542of connector tubes 508 by the second wires 540.

In the case where lateral and/or sagittal constriction of the archportion 502 is desired, the first wire 538 and/or the second wire 540can be replaced by an elastic or a spring configured to exert aconstricting force on the bent anterior ends 514 of the wires 506 or thebent posterior ends 518 of the wires 506, respectively. The replacementof the first wire 538 and/or the second wire 540 with an elastic and/ora spring is similar to the replacement of the first wire 438 and/or thesecond wire 440 with an elastic and/or a spring, as discussed above.

In some embodiments, the occlusal portion of sheath 510 and/or theanterior ends of the connector tubes 508 and/or the flat portions 542are configured to be bonded to the lingual surface of a patient's molarsand/or anterior teeth. In the depicted embodiment, the anterior ends ofthe connector tubes 508 include bonding mechanisms 552, the occlusalportion of sheath 510 includes a bonding mechanism 553, and the flatportions 542 of the connector tubes 508 include bonding mechanisms 554.In one example, one or more of the bonding mechanisms 552-554 is asingle mesh plate, such as a seventy-micron mesh design that is weldedor soldered as a prefabricated design to enhance the bonding strength ofbonding medium to the connector tubes 508 and/or anterior sheath 510. Inanother example, a one or more of the bonding mechanisms 552-554 is adouble mesh plate with two single mesh plates overlaid on each other. Inanother example, one or more of the bonding mechanisms 552-554 includesa surface treatment, such as a sand-blasted surface, that is configuredto improve adherence of the bonding medium when bonding to the connectortubes 508 and/or anterior sheath 510. In another example, one or more ofthe bonding mechanisms 552-554 includes a bonding pad configured toimprove adherence of the bonding medium when bonding to the connectortubes 508 and/or anterior sheath 510. In some embodiments, the bondingpad is usable in combination with other bonding mechanisms (e.g., abonding pad with a single or double mesh layer). In another example, theone or more of the bonding mechanisms 552-554 includes a hinged bondingpad which is hingedly fixed to the anterior ends of the connector tubes508, the sheath 510, and/or the flat portions 542. In some examples, thehinged bonding pad includes a hinge with a vertical axis, a hinge with ahorizontal axis, or a ball hinge that rotates in multiple directions.The hinged pad is configured to rotate in one or more directions and/orextended laterally to better engage the patient's tooth. Examples ofball hinged pads are described below with respect to FIGS. 6A and 6B.

Depicted in FIG. 5C, is the appliance 500 with the arch portion 502 andthe attachment portions 504. In this embodiment, the attachment portions504 include bonding medium 548 configured to attach the connector tubes508 (e.g., to bonding mechanism 552 on the flat portion 542) to theocclusal surface of molar, or bicuspids. The bonding medium 548 preventsthe displacement of the arch portion 502 toward the occlusal. In anotherembodiment, bonding medium 549 is configured to attach to a portion ofthe sheath 510 (e.g., bonding mechanism 553) to the lingual surface ofanterior teeth including incisors and canines. The bonding medium 549prevents displacement of the arch portion 502 toward the occlusal orfacilitates the bodily movement instead of tipping of the anterior teethin saggital expansion or constriction of the dental arch. While thebonding medium 548 is shown only with respect to the appliance 500, anyof the other appliances described herein may include an attachmentportion that includes a bonding material or any other coupling mechanisminstead of the insert-and-slot coupling mechanisms described above. Asshown in this embodiment, the hooks 556 protrude from the bonding medium548 and can be used to tie the bent posterior ends 518 (FIG. 5B) of thewires 506.

Depicted in FIGS. 6A and 6B are embodiments of ball hinged pads, usablein accordance with any of the bonding mechanisms described herein. FIG.6A depicts an embodiment of a bonding pad 680 with a bonding surface682. In some embodiments, the bonding surface 682 includes a single meshlayer, a dual mesh layer, a surface treatment, or any other bondingsurface. The pad 680 is coupled to a connector tube 608 via afixed-length ball hinge arm 684. The fixed-length ball hinge arm 684extends a fixed distance away from the connector tube 608 and permitsthe pad 680 to rotate in one or more directions to better engage thepatient's tooth. FIG. 6B depicts an embodiment of the bonding pad 680with the bonding surface 682. The pad 680 is coupled to a connector tube608 via a telescopic ball hinge arm 686. The telescopic ball hinge arm686 extends away from the connector tube 608 a variable length, whichcan be adjusted by the practitioner to an appropriate distance to engagethe patient's tooth. The telescopic ball hinge arm 686 permits the pad680 to rotate in one or more directions to better engage the patient'stooth.

FIGS. 7A and 7B depict top and cross-sectional views, respectively, of aconnecting system for connecting various conventional orthodonticdevices when the attachment portion does not include a band around themolar. The connecting system includes a track 760 fixedly attached tothe top of a connector tube 708. A crimpable clasp 762 is located aroundthe track 760. In some embodiments, the crimpable clasp 762 is slidablealong the track 760 to be properly positioned. When properly locatedalong the track, the crimpable clasp 762 can be crimped onto the track760 by a practitioner to prevent further sliding of the crimpable clasp762 along the track 760. In some embodiments, the crimpable clasp 762has a cross-sectional shape corresponding to the cross-sectional shapeof the track 760. For example, in the depicted embodiment, the track 760has a cross-sectional “T” shape and the crimpable clasp 762 has across-sectional rectangular shape with an opening for the stem of theT-shaped track 760.

An extension arm 764 extends from the crimpable clasp 762 and engages anupper extension attachment 766. The upper extension attachment 766engages a lower extension arm 767. The lower extension arm is coupled toa bonding pad 768 with a bonding mechanism 770 (e.g., a single layermesh, a double layer mesh, etc.) on a surface of the pad 768 facing theconnector tube 708. The upper extension attachment 766 is configured tomove telescopically with respect to the extension arm 764 such that thedistance between bonding mechanism 770 and the connector tube 708 isvariable. The connector tube 708 is configured to be placed on thelingual side of the tooth and the bonding mechanism 770 is configured tocontact the facial side of the tooth, with the occlusal side of thetooth facing the extension arm 764. When the upper extension attachment766 is in the desired position (e.g., with the connector tube 708 on thelingual side of a tooth and the bonding mechanism in contact with thefacial side of the tooth), a practitioner can crimp the upper extensionattachment 766 on the extension arm 764 to prevent relative movement ofthe crimpable clasp 762 with respect to the upper extension attachment766. The lower extension attachment 767 is configured to movetelescopically with respect to the upper extension attachment 766 suchthat the vertical location of bonding mechanism 770 is variable (e.g.,the location of the bonding mechanism 770 can be moved to contact thebottom, middle, or top portion of the tooth). When the lower extensionattachment 767 is in the desired position, a practitioner can crimp thelower extension attachment 767 on the upper extension attachment 766 toprevent relative movement of the upper extension attachment 766 withrespect to the lower extension attachment 767.

The upper extension attachment 766 can slide along the extension arm 764telescopically to a desired distance between the crimpable clasp 762 andthe upper extension attachment 766. When the upper extension arm 766 isin the desired position, a practitioner can crimp the upper extensionattachment 766 on the extension arm 764 to prevent relative movement ofthe crimpable clasp 762 with respect to the upper extension attachment766. The upper extension attachment 766 engages a lower extensionattachment 767. The lower extension attachment 767 can slide along theupper extension attachment 766 telescopically to a desired distancebetween the upper extension attachment 766 and the lower extensionattachment 767. When the lower extension arm 767 is in the desiredposition, a practitioner can crimp the lower extension attachment 767 onthe upper extension attachment 766 to prevent relative movement of theupper extension attachment 766 with respect to the lower extensionattachment 767.

In some embodiments, the lower extension attachment 767 forms a slot 772or other attachment mechanism. In some embodiments, a tube 773 or otherattachment mechanism is coupled to the lower extension attachment 767and the pad 768. In some examples, the tube 773 has a width equal to orless than the upper and lower extension attachments 766 and 767. In someembodiments, the tube 773 includes a hook 774 extending therefrom. Insome examples, the hook 774 extends substantially vertically down fromthe tube 773. The hook 774 is usable to secure ends of wires of archportions described herein, to secure orthodontic appliances to theconnector tube 708, or to secure any other appliance in the patient'smouth.

In some embodiments, the slot 772, the tube 773, and/or anotherattachment mechanism is configured to be connected to various otherorthodontic devices, such as wires in braces or connection assembliesfrom other class II mechanisms, class III mechanisms, or any other classof mechanisms. In some embodiments, the cross-sectional area of the tube773 is larger than the cross-sectional area of the slot 772. In thisembodiment, the tube 773 is able to accommodate larger wires of someorthodontic devices (e.g., class II mechanisms, class III mechanisms).In this way, the connecting system provides a connection point forcoupling any other orthodontic device to the patient's teeth. In someembodiments, such as the one depicted in FIG. 7A, multiple crimpableclasps 762 and associated extension arms 764 can be used on the sametrack 760 to provide multiple attachment mechanisms on the facial sideof the patient's teeth.

In practical implementation, the bonding mechanism 770 can be bonded tothe facial side of a patient's tooth using a bonding medium. The bondingmedium can further be placed over other portions of the connectionsystem, such as over the extension arm 764 and/or the extensionattachment 766. Bonding medium on the occlusal side of the tooth overthe extension arm 764 and/or the extension attachment 766 may preventinjury to the patient and/or damage to the extension arm 764 from thepatient biting down. Bonding medium on the facial side of the tooth overthe extension attachment 766 may prevent the extension attachment 766from irritating the patient's check.

Referring back to FIGS. 2A to 2E, one way in which the appliance canfunction efficiently is make a proper initial placement of the sheaths210. Each of the sheaths 210 can be placed clinically such that it islocated at the gingival one third of the lingual of the anterior teethand wires 206 make a direct path to the attachment portions 204. Thisplacement ensures that the force created by the loaded spring 216anchored against the molar advance the front teeth more bodily and lesstipping by application of the force more toward the gingival part of thecrown of the anterior teeth.

In some embodiments, the loaded spring 216 is large enough to create thedesired expansion forces between the sheaths 210 and the connector tubes208 inserted to attachment portions 204. This action causes the anterioradvancement of the front teeth, transverse and horizontal expansion ofthe posterior teeth and distalization force on the molars to move themposteriorly.

If the distalization of the molars is indicated, with proper anchoragepreparation of the front teeth and bicuspids by braces, the loadedspring 216 tied to the second bicuspids and force acting on the bands222 on the first or second molars will drive the first and second molarsdistally if desired. When the proper movement of the molars is complete,the spring 216 can be made passive to ensure that no mesial movement ofmolars takes place. The wire connecting the second bicuspids is thendetached. This allows the second and first bicuspids to naturally movetowards the molars under the force of connective tissues.

If the constriction of the dental arches due to over-expanded upper orlower dental arch is indicated, with proper anchorage preparation of themolar and bicuspids teeth by braces, the wires 206 tied to the molar orbicuspids and force acting on the bands 222 on the first or secondmolars will drive the first or second molars or bicuspids lingually ifdesired. This can be done by use of constricting spring or rubber bands,attached to the bent anterior ends 214 of wires 206 inside the sheaths210. The spring 216 can be shortened periodically to allow thismovement. When the proper constriction of the molars is complete, thespring 216 can be made passive to ensure that no further constriction orexpansion of the back teeth horizontally takes place.

To create a lateral force on the teeth, an expansion force is built intoeach half of the appliance. When activated, the force applied to theposterior teeth laterally by contact of the wire 206 to the back teeth,expands the posterior teeth laterally, thus putting pressure on theteeth. The force created by this action aids in the correction ofconstriction of the dental arch to resolve the crowding of the teeth. Italso provides proper space for anterior positioning of the tongueforward and away from pharyngeal airway. Any outward lateral movement ofthe teeth creates more room for the teeth and tongue. The force createdby this action in the upper jaw by expanding the upper jaw bonesbuilding the floor and lateral walls of the nasal cavity aids in thecorrection of constriction of nasal cavity by spreading the upper jawbones outwardly to resolve the resistance to the air passage.

When all tooth movement is complete, the appliance 200 is inactivatedautomatically and now used as a retention device to hold the lateral andfrontal expansion of the dental arches. At the completion of this stage,the appliance 200 can be disconnected by cutting the wires 206 anddisengaging the connections of the inserts 220 and the slots 224. Thebands 222 can be left in place and used for the continuation oforthodontic treatment. As described previously, in some embodiments, thebands 222 have connecting pieces 234 attached to their buccal side whichallows for the attachment of various other types of orthodontic devices.

The appliance 200 also includes structure permitting selectivelimitation of the degree of arch spread. Referring still to FIG. 2, theanterior end 214 of each wire 206 that is received within the sheath 210is bent in the shape of a hook. By tying these anterior ends 214 (e.g.,using stainless steel wire), the lateral expansion of the appliance 200can be stopped short of final expansion limit. In case the fullexpansion capability of appliance is desired, then this processcontinues until the anterior end 214 of the wire 206 is touching thelateral side of the opening 212 inside sheath 210 preventing furtherwithdrawal of the wire 206 from the sheath 210, and thereby limitingspread of the patient's arch to this predetermined extent.

Referring, now, to FIGS. 8 and 9, a further preferred embodiment of anairway expander 810 includes tooth attachment units 812 and anexpandable frame 814. Attachment units 812 are the same as attachmentportions 204, and in one preferred embodiment include a connecting piecesimilar to connecting piece 234, as shown in FIG. 2A and described inaccompanying text. Expandable frame 814 includes first and secondselectively expandable arms 816, each joined to one of the attachmentunits 812 and being joined together by a selectively expandable anteriorbridge 820. Each arm 816 includes an arm shaft 822 having a first end824 attached to one of the attachment units 812 and a second end havinga head 825 (FIG. 9), that is expanded in transverse dimension. For eacharm 816, an arm sheath 826, receives the head 825, which is captured bya narrowed sheath exit 830 (FIG. 9). Further, a position-adjustableblock 832, is positioned on each shaft 822 and is locked in place by aset screw 833. A spring 834 is positioned about the shaft 822. Eachspring 834 has a first end joined to the sheath 826 and a second endjoined to the block 832.

The bridge 820 includes a first bridge shaft 840 attached to a first oneof the arm sheaths 826. Shaft 840 bends inwardly toward the center ofthe patient's mouth and supports a bridge sheath 842. A second bridgeshaft 844 is attached to a second one of the arm sheaths 826 and alsobends toward the center of the patient's mouth. The second bridge shaft844 terminates in a head 846 (not shown, but same as head 825) that isretained in sheath 842. A spring 850 and a position-adjustable block852, held in place by a set screw 853, are situated on the second bridgeshaft 844. Blocks 832 and 852 may assume forms different from thoseshown. In one embodiment shafts 822 and 844 have helical threads and theposition-adjustable blocks rotated to move in position.

The advantages of the above described arrangement include the ability topush the molars backward, pull them forward, push them outwardly or evenpull them inwardly. To push the molars backward, blocks 832 are movedforward, placing springs 834 into compression, and locked in place byset screws 833. The rearward force applied to the molars is a functionof the compression of springs 834 and may be set to achieve a desiredresult. If this action causes heads 825 to abut narrowed regions 830,the effective length of shafts 822 may be increased by moving toothattachment units rearwardly on shafts 822. To pull the molars forward,blocks 834 are moved rearward to place springs 834 into tension.Similarly, to spread the molars, bridge block 852 is moved toward bridgesheath 842. To pull molars inwardly (not a typical goal of orthodontics)block 852 is moved away from sheath 842. Although the above discussionhas been directed to molars, attachment units 812 could be attached toother types of teeth and similar procedures could be performed on, forexample, the bicuspids.

The methods and appliances described herein include automaticinactivation for the transverse expansion or constriction of posteriorteeth, anterior advancement or retraction of the anterior teeth anddistal expansion of the molars, bicuspids and canines. These methods andappliances are capable of being used for correction of the upper dentalarch, upper jaw bone constriction, or lower dental arch constrictionwhich helps to resolve the dental malposition, dental crowding, properroom for tongue position, and nasal cavity expansion for improvement ofairway. In some embodiments, the appliances include loaded springsaround wires connected to attachment portions with connector tubes andextended to an anterior sheath. The spring creates a distalization forceon the first and/or second molars, an anterior extending force onanterior teeth (e.g., canines and incisors), and transverse expansionfor the posterior teeth (e.g., canines, bicuspids, and molars).

While illustrative embodiments have been illustrated and described, itwill be appreciated that various changes can be made therein withoutdeparting from the spirit and scope of the invention.

The embodiments of the invention in which an exclusive property orprivilege is claimed are defined as follows:
 1. An orthodontic appliancefor treatment of a patient, comprising: a. left and right attachmentunits, structured to be secured respectively to left and right molars,joined together by an expandable frame; b. wherein said expandable frameincludes first and second arms, each joined to one of said attachmentunits and being joined together by a selectively-expandable anteriorbridge; c. wherein said selectively-expandable anterior bridge includes:i. a first bridge shaft attached to said arm sheath of said firstselectively expandable arm, said first bridge shaft having a bend andsupporting a bridge sheath; ii. a second bridge shaft attached to saidarm sheath of said second selectively expandable arm, and bendinginwardly toward said bridge sheath, and having an expanded in transversedimension head, retained in said bridge sheath by a narrowed exit; iii.a bridge position-adjustable block, positioned on said second bridgeshaft, outside of said bridge sheath, and including a position lock; iv.a bridge spring positioned around said second bridge shaft and having afirst end joined to said bridge sheath and a second end joined to saidbridge position-adjustable block; d. whereby a user-selectable force,chosen from a set of two alternative force applications that consistsof: i. a force application of pushing outward; and ii. a forceapplication of pulling inward; may be applied to both molars by changingthe position of said bridge position adjustable block, to place saidbridge spring into a state selected from a set of two alternative statesthat consist of: i. a state of compression; and ii. a state of tension.2. The orthodontic appliance of claim 1, wherein said bridge-spring is acoil spring.
 3. The orthodontic appliance of claim 1, wherein saidposition-adjustable block includes a set screw to lock said block inplace.
 4. The orthodontic appliance of claim 1, wherein said molars canbe pushed apart by moving said bridge position-adjustable block farenough toward said bridge sheath to place said bridge spring intocompression.
 5. A method for applying a user adjustable force to themolars of a patient, comprising: a. providing an orthodontic appliancefor treatment of a patient, including: i. left and right attachmentunits, secured respectively to left and right molars, joined together byan expandable frame; b. wherein said expandable frame includes first andsecond selectively expandable arms, each joined to one of saidattachment units and being joined together by a selectively expandableanterior bridge; c. wherein each said arm includes: i. an arm shafthaving a first end attached to one of said attachment units and a secondend having a head expanded in transverse dimension; ii. an arm sheath,receiving said enlarged head, which is captured by a narrowed sheathexit; iii. an arm position-adjustable block, positioned on said shaft,outside of said sheath; iv. an arm spring positioned about said shaftand having a first end joined to said sheath and a second end joined tosaid block; d. wherein said bridge includes: i. a bridge first shaftattached to said sheath of said first arm, said first shaft having abend and supporting a bridge sheath; ii. a bridge second shaft attachedto said sheath of said second arm, and bending inwardly toward saidbridge sheath, and having an expanded in transverse dimension head,retained in said bridge sheath by a narrowed exit; iii. a bridgeposition-adjustable block, positioned on said second shaft, outside ofsaid sheath; iv. a bridge spring positioned about said shaft and havinga first end joined to said sheath and a second end joined to said block;e. adjusting said position of said bridge position-adjustable block,thereby placing said bridge spring into a state, selected from a set oftwo alternative states that consist of: i. a state of compression; andii. a state of tension; by a user selectable amount and thereby actingon said attached molars by one out of a set of two alternative forceapplications, that consists of: iii. pushing said attached molarsoutward; and iv. pulling said attached molars inward.
 6. The method ofclaim 5, wherein said molars are pushed apart by moving said bridgeposition-adjustable block far enough toward said bridge sheath to placesaid bridge spring into compression, locking said bridgeposition-adjustable block in place and leaving said appliance inattachment to said patient's teeth.